{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:58:39Z","timestamp":1779361119751,"version":"3.51.4"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There is limited information on the safety and efficacy of new and repurposed second-line anti-tuberculosis (TB) drugs in pregnant women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pregnant women initiating treatment for multidrug-resistant\/rifampicin-resistant (MDR\/RR) TB from 1 January 2018 to 31 March 2024 were included in this prospective, observational study. Maternal TB treatment and pregnancy outcomes were documented through ongoing record reviews and clinical assessments conducted to describe infant outcomes. Using Poisson regression with robust standard errors, we evaluated factors associated with favorable maternal treatment and pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 70 pregnant women treated for MDR\/RR TB, 53 (76%) were diagnosed with human immunodeficiency virus (HIV). Favorable TB treatment outcomes were reported in 44 (62.9%) women. Sixty-seven (95.7%) of the 70 infants were born alive;median gestational age 38 weeks (interquartile range [IQR], 37.0\u201339.0) and median birth weight 2970 g (IQR, 2560\u20133280). All infants were exposed to bedaquiline. Twenty-three (34.3%) women had unfavorable pregnancy outcomes, with 20 (29.8%) infants born prematurely and\/or with low birth weight. Women with positive sputum smears at treatment initiation were less likely to have a favorable treatment outcome (adjusted risk ratio, 0.33; 95% confidence interval, .17\u2013.66; P = .002). Of the 43 infants evaluated at 12 months, 27 (62.8%) had favorable outcomes, with 10 (23.3%) infants developing TB in their first year of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The high TB\u2013HIV coinfection rate is likely to have contributed to unfavorable pregnancy outcomes. Supportive maternal adherence counseling and infant TB preventive treatment are needed to prevent TB transmission to infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf593","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T12:42:59Z","timestamp":1761568979000},"page":"e1053-e1062","source":"Crossref","is-referenced-by-count":1,"title":["Maternal, Pregnancy, and Infant Outcomes in Women Treated for Multidrug-Resistant\/Rifampicin-Resistant Tuberculosis With Novel and Repurposed Drugs in KwaZulu-Natal, South Africa"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9205-9314","authenticated-orcid":false,"given":"Marian","family":"Loveday","sequence":"first","affiliation":[{"name":"HIV and Other Infectious Diseases Research Unit, South African Medical Research Council , Durban ,","place":["South Africa"]},{"name":"SAMRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit , Centre for the AIDS programme of Research in South Africa, University of KwaZulu-Natal, Durban ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5349-9509","authenticated-orcid":false,"given":"Jennifer","family":"Hughes","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University , Stellenbosch ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuhle","family":"Mchunu","sequence":"additional","affiliation":[{"name":"Biostatistics Research Unit, South African Medical Research Council , Durban ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nonhlanhla","family":"Yende-Zuma","sequence":"additional","affiliation":[{"name":"Biostatistics Research Unit, South African Medical Research Council , Durban ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerry","family":"Holloway","sequence":"additional","affiliation":[{"name":"MDR\/RR-TB Unit, King Dinuzulu Hospital Complex, Sydenham , Durban ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sindisiwe","family":"Hlangu","sequence":"additional","affiliation":[{"name":"HIV and Other Infectious Diseases Research Unit, South African Medical Research Council , Durban ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunitha","family":"Chotoo","sequence":"additional","affiliation":[{"name":"MDR\/RR-TB Unit, King Dinuzulu Hospital Complex, Sydenham , Durban ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nalini","family":"Singh","sequence":"additional","affiliation":[{"name":"MDR\/RR-TB Unit, King Dinuzulu Hospital Complex, Sydenham , Durban ,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2296-2302","authenticated-orcid":false,"given":"James A","family":"Seddon","sequence":"additional","affiliation":[{"name":"Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University , Stellenbosch ,","place":["South Africa"]},{"name":"Department of Infectious Disease, Imperial College London , London ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"2026052019234174400_ciaf593-B1","doi-asserted-by":"crossref","DOI":"10.54394\/CJQU6666","volume-title":"Global tuberculosis report 2024","author":"World Health Organization","year":"2024"},{"key":"2026052019234174400_ciaf593-B2","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ijid.2014.12.014","article-title":"Perspectives on tuberculosis in pregnancy","volume":"32","author":"Bates","year":"2015","journal-title":"Int J Infect Dis"},{"key":"2026052019234174400_ciaf593-B3","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1093\/cid\/cis732","article-title":"Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps","volume":"55","author":"Mathad","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B4","doi-asserted-by":"crossref","first-page":"760","DOI":"10.5588\/ijtld.17.0448","article-title":"Burden of tuberculosis in HIV-positive pregnant women in Cape Town, South Africa","volume":"22","author":"Odayar","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026052019234174400_ciaf593-B5","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1093\/cid\/cix851","article-title":"Poor obstetric and infant outcomes in human immunodeficiency virus-infected pregnant women with tuberculosis in South Africa: the Tshepiso study","volume":"66","author":"Salazar-Austin","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B6","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/1471-0528.14408","article-title":"Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis","volume":"124","author":"Sobhy","year":"2017","journal-title":"BJOG"},{"key":"2026052019234174400_ciaf593-B7","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s11904-022-00641-x","article-title":"Evidence for implementation: management of TB in HIV and pregnancy","volume":"19","author":"Jones","year":"2022","journal-title":"Curr HIV\/AIDS Rep"},{"key":"2026052019234174400_ciaf593-B8","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/jinfdis\/jiq064","article-title":"Maternal tuberculosis: a risk factor for mother-to-child transmission of human immunodeficiency virus","volume":"203","author":"Gupta","year":"2011","journal-title":"J Infect Dis"},{"key":"2026052019234174400_ciaf593-B9","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1093\/cid\/ciaa189","article-title":"Maternal and infant outcomes among pregnant women treated for multidrug\/rifampicin-resistant tuberculosis in South Africa","volume":"72","author":"Loveday","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B10","author":"South African National Department of Health"},{"key":"2026052019234174400_ciaf593-B11","volume-title":"WHO consolidated guidelines on tuberculosis. Module 4: treatment\u2014drug-resistant tuberculosis treatment, 2022 update","author":"World Health Organization","year":"2022"},{"key":"2026052019234174400_ciaf593-B12","author":"South African National Department of Health"},{"key":"2026052019234174400_ciaf593-B13","author":"World Health Organization"},{"key":"2026052019234174400_ciaf593-B14","volume-title":"UNICEF-WHO low birthweight estimates: levels and trends 2000\u20132015","author":"United Nations Children's Fund, World Health Organization","year":"2019"},{"key":"2026052019234174400_ciaf593-B15","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/ije\/dyg099","article-title":"The World Health Organization global database on child growth and malnutrition: methodology and applications","volume":"32","author":"de Onis","year":"2003","journal-title":"Int J Epidemiol"},{"key":"2026052019234174400_ciaf593-B16","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1111\/j.1469-8749.2008.03197.x","article-title":"Global developmental delay and its relationship to cognitive skills","volume":"51","author":"Riou","year":"2009","journal-title":"Deve Med Child Neurol"},{"key":"2026052019234174400_ciaf593-B17","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/cid\/ciad767","article-title":"Pregnancy outcomes in multidrug-resistant tuberculosis in TB-PRACTECAL","volume":"79","author":"Crocker-Buque","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B18","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/cid\/ciad445","article-title":"Pregnancy and birth outcomes in patients with multidrug-resistant tuberculosis treated with regimens that include new and repurposed drugs","volume":"78","author":"Lotia Farrukh","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B19","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1164\/rccm.201001-0077OC","article-title":"Short, highly effective and inexpensive standardized treatment of multidrug-resistant tuberculosis","volume":"182","author":"Van Deun","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"2026052019234174400_ciaf593-B20","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1056\/NEJMoa1901814","article-title":"Treatment of highly drug-resistant pulmonary tuberculosis","volume":"382","author":"Conradie","year":"2020","journal-title":"N Engl J Med"},{"key":"2026052019234174400_ciaf593-B21","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1056\/NEJMoa2119430","article-title":"Bedaquiline-pretomanid-linezolid regimens for drug-resistant tuberculosis","volume":"387","author":"Conradie","year":"2022","journal-title":"N Engl J Med"},{"key":"2026052019234174400_ciaf593-B22","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1056\/NEJMoa1811867","article-title":"A trial of a shorter regimen for rifampin-resistant tuberculosis","volume":"380","author":"Nunn","year":"2019","journal-title":"N Engl J Med"},{"key":"2026052019234174400_ciaf593-B23","doi-asserted-by":"crossref","first-page":"47","DOI":"10.7196\/SAMJ.2023.v113i11.497","article-title":"Treating drug-resistant tuberculosis in an era of shorter regimens: insights from rural South Africa","volume":"113","author":"Lotz","year":"2023","journal-title":"South Afr Med J"},{"key":"2026052019234174400_ciaf593-B24","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1093\/cid\/ciae145","article-title":"Treatment of multidrug-resistant or rifampicin-resistant tuberculosis with an all-oral 9-month regimen containing linezolid or ethionamide in South Africa: a retrospective cohort study","volume":"78","author":"Morgan","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B25","doi-asserted-by":"crossref","first-page":"e153","DOI":"10.1093\/cid\/ciaf112","article-title":"Treatment outcomes with an oral short course regimen for rifampicin-resistant tuberculosis in a high HIV prevalence, programmatic setting in South Africa","volume":"81","author":"Stadler","year":"2025","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B26","doi-asserted-by":"crossref","first-page":"354208","DOI":"10.1155\/2011\/354208","article-title":"HIV-associated tuberculosis in the newborn and young infant","volume":"2011","author":"Adhikari","year":"2011","journal-title":"Int J Pediatr"},{"key":"2026052019234174400_ciaf593-B27","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/0020-7292(94)90064-7","article-title":"Perinatal outcome in pregnancies complicated by pulmonary tuberculosis","volume":"44","author":"Jana","year":"1994","journal-title":"Int J Gynecol Obstetr"},{"key":"2026052019234174400_ciaf593-B28","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1056\/NEJM199908263410903","article-title":"Obstetrical outcomes among women with extrapulmonary tuberculosis","volume":"341","author":"Jana","year":"1999","journal-title":"N Engl J Med"},{"key":"2026052019234174400_ciaf593-B29","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1093\/cid\/ciaf233","article-title":"The impact of pregnancy on tuberculosis treatment outcomes: an analysis of Brazilian national surveillance data 2016\u20132022","volume":"82","author":"Chiang","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026052019234174400_ciaf593-B30","doi-asserted-by":"crossref","first-page":"e1717","DOI":"10.1016\/S2214-109X(19)30422-X","article-title":"Effect of co-trimoxazole prophylaxis on morbidity and mortality of HIV-exposed, HIV-uninfected infants in South Africa: a randomised controlled, non-inferiority trial","volume":"7","author":"Daniels","year":"2019","journal-title":"Lancet Global Health"},{"key":"2026052019234174400_ciaf593-B31","doi-asserted-by":"crossref","first-page":"178","DOI":"10.11604\/pamj.2018.30.178.15837","article-title":"Predictors of loss to follow up among HIV-exposed children within the prevention of mother to child transmission cascade, Kericho County, Kenya, 2016","volume":"30","author":"Kigen","year":"2018","journal-title":"Pan Afr Med J"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaf593\/65025987\/ciaf593.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/5\/e1053\/65025987\/ciaf593.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/5\/e1053\/65025987\/ciaf593.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T23:23:50Z","timestamp":1779319430000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/82\/5\/e1053\/8306070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10,29]]},"published-print":{"date-parts":[[2026,5,20]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaf593","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5,15]]},"published":{"date-parts":[[2025,10,29]]}}}